What is the treatment for hordeolum (stye)?

Treatment of Hordeolum (Stye)

Warm compresses applied for 5-10 minutes several times daily are the first-line treatment for hordeolum, as recommended by the American Academy of Ophthalmology. 1

Primary Treatment Approach

Conservative management should be initiated immediately:

• Apply warm compresses to the affected eyelid for 5-10 minutes, multiple times per day to increase blood circulation and relieve pain 1
• Clean eyelid margins with mild soap or commercial eyelid cleansers after applying warm compresses 1
• Perform gentle massage of the affected area following warm compress application to help express the obstructed gland 1

This conservative approach is effective because hordeolum often drains spontaneously and resolves without additional intervention 2, 3

When to Escalate Treatment

Consider topical antibiotics for:

• Moderate to severe cases 1
• Signs of spreading infection 1

Reserve oral antibacterial therapy for:

• Severe cases with spreading infection 1
• Presence of systemic symptoms 1

Critical Management Principles

Do NOT squeeze or attempt to "pop" the hordeolum - this may spread infection 1

Discontinue eye makeup use during active infection 1

If no improvement occurs after 48 hours of appropriate therapy, modify the treatment approach 1

Management of Recurrent Hordeola

For patients with recurrent episodes:

• Implement a more aggressive eyelid hygiene regimen 1
• Evaluate for underlying conditions including:
  • Blepharitis 4, 1
  • Meibomian gland dysfunction 4, 1
  • Rosacea 4
  • Seborrheic dermatitis 5

Red Flags Requiring Further Evaluation

Refer or investigate further if:

• Marked asymmetry or resistance to therapy 4, 1
• Unifocal recurrent lesions in the same location 4, 1
• Eyelid margin distortion or lash loss (madarosis) 4
• Unilateral chronic blepharitis unresponsive to therapy 4
• Recurrence in elderly patients (raises suspicion for sebaceous carcinoma) 4, 1

Evidence Quality Note

While warm compresses are universally recommended by the American Academy of Ophthalmology 1, no high-quality randomized controlled trials exist to support or refute the effectiveness of non-surgical interventions for acute internal hordeolum 2, 3. The recommendations are based on clinical consensus and observational experience rather than rigorous trial data. Despite this limitation, warm compresses remain the standard of care given their safety profile, low cost, and biological plausibility for promoting drainage 1.